Lower back pain will affect most of us in our lifetime. In most cases, with graded activity and using some pain relief in the form of medications and/or heat/ice and the help of physiotherapist people will see their pain significantly reduce and return to full activity. Occasionally, you will be referred for an MRIif you have persistent low back pain, or pain reffering into you leg, past your knee.
With the constant evolution in imaging techniques, there has been an increasing emphasis on the use of Magnetic Resonance Imaging (MRI) to help us determine and pinpoint the “cause” of the pain. While this can be helpful in some scenarios, the use of MRI is now under scrutiny as researchers are now questioning how closely someone’s MRI results actually matches with their cause of back pain.
One issue with this detailed imaging is that in most cases, there will always be some form of spine degeneration which can be interpreted as the cause of someone’s pain. This can create an abnormal view of how people view their back and in turn their long term outcomes if not properly explained.
If you have recently had an MRI or you are questioning whether one is required, it should be always analysed in the context of your symptoms. There has been interesting research by Brinkjiki et al into the asymptomatic (pain free) population and their imaging findings. What they found was that in 3110 asymptomatic individuals, meaning they had no history of back pain, was that there are a large proportion of “positive” findings (some form of spinal degeneration).
To give you an idea they found disc bulge in 30% of 20 yr olds and up to 60% in 50 year olds. And disc degeneration of 37% in 20 year olds and up to 80% in 50 year olds. For the full numbers detailing findings from 20-80 yr old and disc degeneration to facet degeneration and others please look up the article below.
But what does this mean?
The overall implication is that many people believe that when they see these results their pain is linked to these results. However, findings like this proves to us that spine and disc degeneration does not necessarily link to pain which is why as physiotherapists we encourage people to look past the scan results and to promote positive behaviour strategies as you can be pain free.
Sometimes your scan results will match your symptoms however most physiotherapists will still continue to treat you the same way. This is because we assess your bodies on how they are responding where in some cases, your body’s protective response and your change in behaviour can actually alter your pain sensations. In most cases your body will look after healing itself and we need to make sure you are managing the best you can and return to moving and trusting your back again.
The best thing to take from this is that don’t assume that your MRI means ongoing lasting pain. Most people will show some form of back “degeneration” and in most cases it doesn’t have to cause pain. Come see us at The Physio Centres to learn how to take control again!
W. Brinjikji et al Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015 April ; 36(4): 811–816.